RAVI JOHNSON
Dependent on policy B03M000226
Claims
2
Attributed to this person
Charged
1,234.00
Total submitted
Denied
720.00
1 denied claims
Patient responsibility
102.80
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | RAVI JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000226 |
| Date of birth | 15 Jul 2010 |
| Plan | SILVER HMO |
| Covered from | 23 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 102.80 |
| Total | 102.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000924 | 25 Dec 2025 | 720.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 720.00 |
| CLM0000923 | 10 May 2024 | 514.00 | NORTHSTAR MUTUAL | Not denied | — |